The 1994 genocide against the Tutsi destroyed the health system in Rwanda. It is impressive that a small country\nlike Rwanda has advanced its health system to the point of now offering near universal health insurance coverage.\nThrough a series of strategic structural changes to its health system, catalyzed through international assistance,\nRwanda has demonstrated a commitment towards improving patient and population health indicators. In\nparticular, the rapid scale up of antiretroviral therapy (ART) has become a great success story for Rwanda. The\ncountry achieved universal coverage of ART at a CD4 cell count of 200 cells/mm3 in 2007 and increased the\nthreshold for initiation of ART to �350 cells/mm3 in 2008. Further, 2013 guidelines raised the threshold for initiation\nto �500 cells/mm3 and suggest immediate therapy for key affected populations. In 2015, guidelines recommend\noffering immediate treatment to all patients. By reviewing the history of HIV and the scale-up of treatment delivery\nin Rwanda since the genocide, this paper highlights some of the key innovations of the Government of Rwanda\nand demonstrates the ways in which the national response to the HIV epidemic has catalyzed the implementation\nof interventions that have helped strengthen the overall health system.
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